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Inhaled steroids for COPD

 

Clinical bottom line

In patients with clearly defined moderatley severe COPD, relatively high daily doses of inhaled corticosteroids improves FEV1 over two years of treatment.


Reference

PM van Grunsven et al. Long term effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a meta-analysis. Thorax 1999 54: 7-14.

Systematic review

The search for studies involves six electronic databases, including the Cochrane Library for studies investigating inhaled corticosteroids on COPD. Studies had to have a minimum of 24 months of follow up to assess the effect on long-term decline in lung function. Only randomised, placebo-controlled studies were included. Only patients with clearly defined COPD were included, and the review process included contacting authors of original studies to ensure that this was the case.

Results

There was data on three trials with 303 patients. Doses of corticosteroids were prednisolone 5 mg/day, beclamethasone 1500 µg/day and 800 µg beclamethasone a day. There were 95 patients on inhaled steroids and 88 on placebo.

Over two years, the mean pre- and post-bronchodilator FEV1 values did not change with placebo, but rose with inhaled corticosteroids.

There was no difference in the number of annual exacerbations between inhaled corticosteroids and placebo, nor in the drop-out rates between the groups.

Comment

Even though this is an exceptionally detailed and competent meta-analysis, its weakness is that the number of patients was small initially and fell over two years of follow up. Despite this, the evidence was that high dose inhaled corticosteroids was helpful.